Clarification on gettin Rx written --ADD TO COLL WISDOM

[lanndi]

I am preparing a letter to my allergist (who requested the sleep study) regarding getting my xpap Rx. I really think I can get her to write out what I want because a) she has already shown a collaborative approach to her care for me; and b) she probably doesn't know that much about xpap equipment and will welcome my research.

So I have the following info from your collective wisdom, but I have a couple questions.
-- Since I have not had a chance to see either machine in person, how can I have the Rx written to be either or?
-- Is the Resmed S8 Elite w/EPR an A-PAP or a C-PAP?
-- On #5 for Resmed & REMstar -- Does the Resmed provide AHI and leak info -- which I've already learned is important to a successful xpap experience.

1] Resmed S8 Elite w/EPR & integrated humidifier
2] Pressure ____ cms
3] EPR setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Efficacy & Usage Data access
7] Nasal mask of patient's choice.

Or:

1] Respironics REMstar M Series Auto w/A-Flex (w/integrated humidifier if you prefer)
2a] Minimum pressure (whatever your doctor has determined)
2b] Maximum pressure (whatever your doctor has determined)
3] A-Flex setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Show AHI/Leak feature On
7] Nasal mask of patient's choice.[/code]

THanks for your help.

Lori

[provider]

Make sure you request a machine capable of recording data! Also, the ramp, Flex settings, heat level settings, etc are all comfort features and you don't need your doctor to prescribe a set level. Whichever machine you choose ensure your provider educates you on these features so that you can make adjustments to meet your comfort.

[Pugsy]

The ResMed 8 Elite is a CPAP only. No Auto features. You can view leakage, AI, Hi and AHI easily on the LCD screen.
If you are wanting auto capabilities you might look at Resmed's Autoset. If you aren't planning on getting the software this machine will at least give you the break down where the AHI total came from.

The Respironics M Series Auto CPAP can be used as an autoCPAP or straight CPAP. I have this model with C Flex. It does show the AHI's and leak rates but it does not break them down to AI's or Hi's. It also only offers a 7 day average or 30 day average of these stats. I bypassed the average so that I get daily stats by resetting to zero accumulated data shown on the LCD screen (it does not erase the data from the smart card). To get a break down of AI's and HI's I need the software and card reader. A Flex is a little fancier than C Flex. I am using CFlex 1 setting. I don't even need the ramp (even with minimum pressure at 7 or . It takes me maybe 2 minutes to get used to the pressure. This for me has been the easiest hurdle.

Good luck. You are were I was in the decision making process about 10 days ago.
Brenda

[lanndi]

Brenda --

What did your Doc write for your prescription? Did you have any probs with your DME?

How are you feeling?

Lori

[Pugsy]

I have not seen the doctor for follow up but I did speak with his nurse early last week prior to the titration study. She told me he wouldn't write for auto unit unless he felt like I needed it. He would write for brand and model of choice though. So I have not seen how he actually worded his prescription. All I know is 8 cm of pressure and CPAP. Based on this information and the way I was treated initially by DME local I opted to purchase my machine from an individual. It was brand new, I have warranty card. Zero hours of use on it. Price was so good that my cash outlay was less than going through DME plus I got the machine I wanted.

I would think that if your doctor was willing to write a prescription for APAP (brand and model per patient's choice) along with the other parameters you have already outlined, you would have clear sailing to battle the DME. APAP's don't cost all that much more than CPAP's.

My first DME ordered a Fishel Paykel without even discussing anything at all with me. I didn't even know they had the orders. It was the most basic unit with no way for me to monitor anything. Then they tell me it won't be in the first of June. Duh... completely unacceptable. I told them I wanted a Respironics and they flat out refused to even consider it. They said "they had too much trouble with them". Then I asked about getting a Swift LT for her from them. Geezz what dumb a@@. Told me I had to be fitted for the head gear and then they would have to order it and it wouldn't be in for a week either. I told them we couldn't do business together. They asked if I was refusing CPAP treatment?? I told them "No, I am refusing to do business with you and I will find another DME for my supplies".
They offered to fax my orders to another DME of my choice which I had them do.

Then I went down to the second DME office and flat out told them that I was going to get so and so machine from an individual and that I wanted a local supplier for my other stuff but if they weren't willing to be helpful with me wanting to be proactive in my own treatment then I would simply buy online. The guy laughed and told me that anything he could do to help me help myself is what he would do. Told me he would show me how to access the data and adjust the comfort features if I wished. I laughed and told him I already knew how to do this and he laughed and said it really isn't all that difficult. He would have got me the Respironics unit if I wished though they stock ResMeds locally but have Respironics in the big office 30 miles away. One day turn around. He told me that the Respironics M series AutoCPAP was an excellent machine and would serve me well. Didn't even try to talk me out of it. He stocks Swift LT for Her in stock because it is his best seller and I left with it and the 3 sizes of pillows (he did show me that medium is too large for me and small is ok but really XS will likely be better) along with an extra filter for my machine (no charge for the filter).

I think once he realized that I was the type of person who did better knowing what was going on he didn't have a choice but to concede. Anyway, that was sorted out to my satisfaction. I wasn't ugly about it but I was firm about my desires to be proactive. I have to drive 12 miles to him but that is just fine by me. He listened.

Regarding your question as to how I am doing? Give me till later to answer that in detail as I just now this minute received my software. I have no issues falling to sleep with the mask and machine on. I don't use the ramp. This part of the treatment has presented no problems but I am not sleeping well. I wake up often and I am still very tired and sleepy during the day. I have some pain and arthritis issues that have monkeyed up things a bit. I will install the software in a bit and look at data more closely. Only thing I wish this machine have that it doesn't is the ability to break down the AI and HI totals instead of giving me one AHI total on the LCD screen. Since I had already planned on getting the software not a big deal but for someone with no money for software and wishing access to that particular data it sure would put a crimp in things. More to come in a separate thread.
Brenda

[Gerald]

Lori.....

Because I've been down the road of "telling my doctor how to write the prescription".....I can make some suggestions.

Keep it simple. All you have to do is request a prescription like the following:

1] Respironics REMstar M Series Auto w/A-Flex w/integrated humidifier
2a] Minimum pressure (whatever your doctor has determined)
2b] Maximum pressure (whatever your doctor has determined)
7] Nasal mask of patient's choice.

On your own, purchase "Viewer" software and a card reader from CPAP.com.

Once you have your machine, those of us on this forum can show you how easy it is to set it up the way you want it to operate.

Don't let'em talk you into anything else. You're doing everything "right"......but, if your equipment is to be furnished by a DME (paid for by "insurance"), you're about to take a walk through a swamp filled with "snakes-n-gators".

Prepare for battle.

Gerald

[riverdreamer]

Here is how my script is written:

Diagnosis - (Mine includes OSA, hypertension (PA) and excessive daytime sleepiness. The two additions to OSA support the need for an APAP with my insurance. This will depend on what your insurance covers.)

Patient's Preference of CPAP at ___ cm H2O.
OR
Patient's Preference of APAP at _____ to _____ cm H2O.

Heated Humidifier
Mask
All supplies (Masks, mask cushions, Headgear, Chin Strap, Disposable/Non-disposable filters, Tubing, Humidifier chamber) as needed for 5 years.
Length of need 99 (99 = lifetime)

Please set so patient can see usage and efficacy data.

With this script I was able to get any machine I wanted, no problems. First I spoke over the phone to several DME providers, to find who had a variety of machines (some only carry one brand, or even one model) and who had masks for trying on, and the greatest variety of masks.

This script has allowed me to change masks and add extras like a chin strap without the DME having to contact the doctor's office. They even gave me the clinical guide after a quick check with the doctor. It allows you the option of looking at different machines in the DME, since no specific machine is named, or you can change your mind later and purchase a different machine. It is possible some DME may still try to give you the less capable machines, but with the specification of access to efficacy data, that route is cut off. With a very specific script, if you ever found you need to change machines, you would need a new script.

[lanndi]

Thanks, Riverdreamer. That looks like a great way to ask for the Rx to be written! Flexibility, yet guaranteed to get me good equipment.

Lori

[GumbyCT]

Keep in mind that like each of us, each DME is very different and what one is willing to accept another may just argue, tooth and nail, in an effort to control your therapy. Some Insurances will allow you to choose from many DME's while others permit only one. Cigna and Apria come to mind. And because Apria knows YOU have no other option, they treat you very differently.

Also you should know that regardless what else is on the script a pressure(s) is required. I was going to suggest a generic version like what Riverdreamer has suggested above. Keep in mind that is makes NO mention of "data capable" machine. Then some DME's consider hours of use to meet the data capable requirement. So it becomes much like a chess game.

That is where the make/model machine specific prescriptions cannot be challenged.

The point I am trying to make is - no one script style will fit every DME's requirements. I know some time ago Slinky posted some very good suggestions on what to include to be sure you got what you wanted. It may be worth your time to search her posts then narrow it down. Then again, it could be in "Where a Newbie Should Start".

HTH

[lanndi]

Can someone add this to collective wisdom? I think there's some very helpful discussions in this thread that add to the discussion about choosing a machine.

[Pugsy]

Lori,
Have you made a decision on which way you want to go yet?
Brenda

[lanndi]

I know some time ago Slinky posted some very good suggestions on what to include to be sure you got what you wanted. It may be worth your time to search her posts then narrow it down. Then again, it could be in "Where a Newbie Should Start".
HTH

How do I search for this thread? When I searched for Slinky, I got oodles of posts that had Slinky within the post -- but not by Slinky.

When I clicked on Slinky's name, I just got the profile?

[lanndi]

Lori,
Have you made a decision on which way you want to go yet?
Brenda

Not yet. THe DME I'm going to work with said they'll bring a variety of models for me to look at. I do much better comparing real things than just through written descriptions.

I faxed a letter to my doc late Friday with a request on how to write the Rx -- however, there are some good suggestions that have come through since I sent the fax, so I may revise my request.

Thanks to this group, I did request data capable, auto and set for user to have access to data!

[riverdreamer]

Also you should know that regardless what else is on the script a pressure(s) is required. I was going to suggest a generic version like what Riverdreamer has suggested above. Keep in mind that is makes NO mention of "data capable" machine. Then some DME's consider hours of use to meet the data capable requirement. So it becomes much like a chess game.

If the rx says to make EFFICACY data available, it does not allow the DME an out. Efficacy means AHI, AI, HI, and leaks. It is NOT compliance data, which is # of hours used.

[jrfoster]

The ResMed 8 Elite is a CPAP only. No Auto features. You can view leakage, AI, Hi and AHI easily on the LCD screen.
If you are wanting auto capabilities you might look at Resmed's Autoset. If you aren't planning on getting the software this machine will at least give you the break down where the AHI total came from.

The Respironics M Series Auto CPAP can be used as an autoCPAP or straight CPAP. I have this model with C Flex. It does show the AHI's and leak rates but it does not break them down to AI's or Hi's. It also only offers a 7 day average or 30 day average of these stats. I bypassed the average so that I get daily stats by resetting to zero accumulated data shown on the LCD screen (it does not erase the data from the smart card). To get a break down of AI's and HI's I need the software and card reader. A Flex is a little fancier than C Flex. I am using CFlex 1 setting. I don't even need the ramp (even with minimum pressure at 7 or . It takes me maybe 2 minutes to get used to the pressure. This for me has been the easiest hurdle.

Good luck. You are were I was in the decision making process about 10 days ago.
Brenda

What are the steps to erase the stats back to zero? I have the M series also and would like to know how to do that! Thanks.

Jeff